癌症儿童多症状测评工具的范围综述

目的 比较国内外用于癌症患儿的多症状测评工具,为癌症患儿症状管理提供参考。方法 计算机检索PubMed、Web of Science、EMbase、中国期刊全文数据库、中国生物医学文献数据库、万方数据库,查找用于测评癌症患儿多症状评估的工具,检索时限为从建库至2022年9月。提取各工具的条目数、信效度、评分方法、适用对象等信息,对纳入工具进行描述。结果 最终纳入9个持续性评估工具,共28篇全文文献,其中9篇关于评估工具的开发、19篇关于评估工具的运用。结论 目前癌症患儿的多症状测评工具良莠不齐,有必要开发针对不同群体的多症状群测评工具,以保证动态追踪患儿的症状变化,拟订干预措施,促进癌症患儿的症状管理。

慢性阻塞性肺疾病急性加重病人多症状现状及其特征分类研究

总结与归纳慢性阻塞性肺疾病急性加重期(AECOPD)患者的多症状以及特征,并分类制定针对性的干预措施。方法 采用医院自制的资料调查表、疾病感知问卷、圣乔治呼吸问卷、COPD自我效能量表等,面向我院2023年1月~2024年1月期间随机择取的224例患者进行调查,所搜集的数据进行主成因子分析以及Pearson相关性分析等。结果 根据调查结果,针对224患者多症状的严重程度,划分为低度组(n=112)、中度组(n=66)、重度组(n=46)三个亚组,在组间比较中发现,重度组病人mMRC得分、疾病感知评分显著更高(p<0.05),但是自我效能总分、圣乔治呼吸评分等以及体力活动等明显低于低度(p<0.05)?Pearson相关性分析结果显示,224例患者的严重后果与疾病影响?严重后果与呼吸问卷总分呈现一定相关性(p<0.05)。结论 慢性阻塞性肺疾病急性加重期(AECOPD)的临床症状明显存在群体异质性,也存在一定的负性疾病感知,导致患者面临不同程度的困扰,今后临床人员可针对三个亚组的症状严重程度以及具体表现,进行个体化症状管理。

心理问题多症状共存现象对大学生心理咨询的启示

大学生的心理问题存在着多症状共存的现象,这种现象的产生不仅因症状产生的叠加或倍增效应使学生们体会到更多的痛苦,也给心理教师带来更多的咨询困惑。通过症状因子间的相关分析得出的多症状心理问题共存图示,证明了焦虑症状是所有症状的核心症状,解释了症状间的演化过程。同时文章也提出了可以从焦虑情绪入手,理顺症状间的关系,关注反方向症状的发生,落脚于焦虑症状的改善四个方面来应对心理问题多症状共存现象。

心理问题多症状共存现象对大学生心理危机预防的启示

大学生心理问题存在大量的症状共存现象,这可能导致存在心理问题的大学生的心理压力产生叠加或倍增效应,并促使大学生的痛苦体验泛化和深化,进而演变成为心理危机。为预防和化解大学生心理危机,应在全面心理健康普查的基础上,将大学生心理危机干预工作关口前置,对可能存在心理问题的重点对象进行预约式跟踪咨询;创新咨询方式,提高多症状心理问题的咨询效果;围绕心理危机的预防和化解制订综合性的教育和疏导措施。

癌症儿童和青少年化疗周期内多症状负担纵向调查分析

目的描述癌症患儿化疗周期内的多症状负担现状及变化,为其症状的精准化管理和干预提供借鉴和参考。方法采用便利抽样法选取2019年1-12月在上海市某两家三级甲等医院接受化疗的5~17周岁癌症儿童和青少年,围绕一个骨髓抑制化疗周期的四个时间点(化疗前0~1 d、化疗开始后的2~3 d、开始后的7~10 d和下一疗程开始前1~2 d)进行调查,采用一般资料问卷及回忆症状评估量表(memorial symptom assessment scale,MSAS 10-18)评估癌症患儿化疗期间经历的多个症状。结果84例癌症患儿在化疗开始后2~3 d生理症状负担最高,心理症状负担在新化疗疗程开始前最高,化疗周期内的生理、心理症状、症状困扰指数及MSAS症状负担的变化均具有统计学意义(均P<0.05)。结论癌症患儿在化疗期间受到多种心理、生理症状的困扰且随着治疗时间的变化而变化,医护人员应及时准确地评估患儿化疗周期的症状并给予针对性的管理和干预,从而逐步实现精准、个体化的动态症状管理。

潜类别模型用于白血病患儿多症状特征分类研究

目的对白血病患儿的多症状进行特征分类,为针对性护理干预提供参考。方法采用一般资料调查表和中文版儿童自我报告结局测量信息系统中的儿童简表对218例白血病患儿进行横断面调查,采用潜类别模型根据患儿多症状特征及群体异质性进行特征分类。结果分为多症状轻组(42例)、多症状临界组(110例)和多症状困扰组(66例)3个亚组,其中多症状困扰组身体功能障碍程度显著高于另两组(均P<0.05),多症状轻组同伴关系显著优于多症状困扰组(P<0.05)。结论白血病患儿的多症状存在群体异质性,对个体造成不同程度的困扰;多症状3个亚组的划分可作为临床护理的参照。

醒脾养儿颗粒联合山莨菪碱治疗小儿原发性多症状性遗尿症的临床观察

目的：观察醒脾养儿颗粒联合山莨菪碱治疗小儿原发性多症状性遗尿症的临床疗效。方法：2010年10月～2013年2月被确诊的原发性多症状性遗尿症患儿，按就诊顺序分成实验组和对照组，实验组用醒脾养儿颗粒联合山莨菪碱治疗，对照组单纯用醒脾养儿颗粒治疗，比较两组患儿治疗的总有效率、复发率等。结果：对照组总有效率为57.5%，实验组总有效率为82.9%，差异有统计学意义，复发率差异无统计学意义。结论：醒脾养儿颗粒联合山莨菪碱治疗小儿原发性多症状性遗尿症疗效显著。

恶性实体瘤患儿放疗期间症状发生现状的调查及分析

目的:调查恶性实体瘤患儿放疗期间的症状现状及其负担。方法:采用便利抽样选取2018年10月至2019年12月在上海市某三级甲等医院放射科正在接受放疗的5~18岁恶性实体瘤患儿进行调查,通过人口学及疾病相关资料问卷及回忆症状评估量表(MSAS)评估恶性实体瘤患儿在放疗期间的症状。结果:128名患儿各症状的发生率为13.3%~71.9%,发生率排前5的症状依次为恶心或感觉想吐、头发变少、缺乏体力或活力、呕吐、口干。症状负担排前5位依次为头发变少、恶心或感觉想吐、缺乏体力或活力、呕吐、没有食欲,1周内未进行化疗的患儿的生理症状负担、总困扰指数及MSAS总分均少于1周内同步进行化疗的患儿(P<0.01),年龄、性别、疾病类型对各维度症状负担的影响无统计学意义(P>0.05)。结论:恶性实体瘤患儿放疗期间受到多种不良症状的困扰,特别是同步进行化疗的患儿,医护人员应针对不同放疗阶段患儿症状体验及负担给予相应的症状管理指导。

Expression of sialyl Lewis^a relates to poor prognosis in cholangiocarcinoma

AIM: High levels of serum sialyl Lewisa (sLea) are frequently found in cholangiocarcinoma (CCA) patients and have been suggested to be a serum marker for CCA. However, the significance of this antigen in CCA is unknown. In this study, the clinical significance of sLea expression in CCA tissues and the possible role of sLea in vascular invasion in vitro were elucidated. METHODS: Expression of sLea in tumor tissues of 77 patients with mass-forming CCA and 33 with periductal infiltrating CCA was determined using immunohistochemistry. The in vitro assays on adhesion and transmigration of CCA cells to human umbilical vein endothelial cells were compared between CCA cell lines with and without sLea expression. RESULTS: sLea was aberrantly expressed in 60% of CCA tumor tissues. A significant relationship was found between the frequency of sLea expression and the mass-forming type CCA (P= 0.041), well differentiated histological grading (P=0.029), and vascular invasion (P=0.030). Patients with positive sLea expression had a significantly poorer prognosis (21.28 wk, 95% CI=16.75-25.81 wk) than those negative for sLea (37.30 wk, 95% CI=27.03-47.57 wk) (P<0.001). Multivariate analysis with adjustment for all covariates showed that patients positive for sLea possessed a 2.3-fold higher risk of death than patients negative for sLea (P<0.001). The role of sLea in vascular invasion was demonstrated using in vitro adhesion and transmigration assays. KKU-M213, a human CCA cell-line with a high expression of sLea, adhered and transmigrated to IL-1β-activated endothelial cells of the human umbilical vein more than KKU-100, the line without sLea expression (P<0.001). These processes were significantly diminished when the antibodies specific to either sLea or E-selectin were added to the assays (P<0.001) CONCLUSION: This study demonstrates the clinical significance of sLea expression in vascular invasion, and an unfavorable outcome in CCA. The role of sLea in vascular invasion which may lead to poor prognosis is supported by the in vitro adhesion and transmigration studies.

Surgical management of polycystic liver disease

Adult polycystic liver disease (PCLD) is an autosomal dominant condition commonly associated with autosomal dominant polycystic kidney disease (ADPKD). However in the last decade, it has been recognized that there is a distinct form of autosomal dominant PCLD that arises without concomitant ADPKD. Early knowledge of the pathogenesis was gained from the study of hepatic cysts in patients with ADPKD. Bile duct overgrowth after embryogenesis results in cystic hepatic dilatations that are known as biliary microhamartomas or von Meyenburg complexes. Further dilatation arises from cellular proliferation and fluid secretion into these cysts. There is a variable, broad spectrum of manifestations of PCLD. Although PCLD is most often asymptomatic, massive hepatomegaly can lead to disabling symptoms of abdominal pain, early satiety, persistent nausea, dyspnea, ascites, biliary obstruction, and lower body edema. Complications of PCLD include cyst rupture and cyst infection. Also, there are associated medical problems, especially intracranial aneurysms and valvular heart disease, which clinicians need to be aware of and evaluate in patients with PCLD. In asymptomatic patients, no treatment is indicated for PCLD. In the symptomatic patient, surgical therapy is the mainstay of treatment tailored to the extent of disease for each patient. Management options include cyst aspiration and sclerosis, open or laparoscopic fenestration, liver resection with fenestration, and liver transplantation. The surgical literature discussing treatment of PCLD, including techniques, outcomes, and complication rates, are summarized in this review.

Matrix metalloproteinase-9-1562C>T polymorphism may increase the risk of lymphatic metastasis of colorectal cancer

AIM. To explore the role of the matrix metalloproteinase-9 （MMP-9） polymorphism in colorectal cancer （CRC） in a northeast Chinese population.METHODS： Genotyping of MNP-9-1562C〉T and 279R〉Q polymorphisms was carried out on blood samples from 137 colorectal cancer patients and 199 controls using polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP）. Multivariate logistic regression models were used to calculate adjusted odds ratios （OR） and 95% confidence intervals （95% CI）.RESULTS： The distribution of IVllVlP-9 -2562C〉T and 279 R〉Q genotype was not significantly associated with the risk of CRC. However, the risk of Ilymph node metastasis of CRC was increased in patients with the -1562T allele （OR = 2.601; 95% CI = 1.160-5.835; P = 0.022）. The frequency of MMP-9 279RR ＋ RQ genotype was higher than the QQ genotype among CRC patients younger than sixty years old （OR = 0.102, 95% CI = 0.013-0.812; P = 0.012）.CONCLUSION： Our results indicated that the MMP-9- 1562C〉T polymorphism affects lymph node metastasis of CRC. In addition, the MMP-9 279R allele may lead to a younger age of onset of colorectal cancer.

The effect of acute exercise on cognitive performance in children with and without ADHD

Background： Attention deficit hyperactivity disorder （ADHD） is a common childhood disorder that affects approximately 11% of children in the United States. Research supports that a single session of exercise benefits cognitive performance by children, and a limited number of studies have demonstrated that these effects can also be realized by children with ADHD. The purpose of this study was to examine the effect of acute exercise on cognitive performance by children with and without ADHD. Methods： Children with and without ADHD were asked to perform cognitive tasks on 2 days following treatment conditions that were assigned in a random, counterbalanced order. The treatment conditions consisted of a 30-min control condition on 1 day and a moderate intensity exercise condition on the other day. Results： Exercise significantly benefited performance on all three conditions of the Stroop Task, but did not significantly affect performance on the Tower of London or the Trail Making Test. Conclusion： children with and without ADHD realize benefits in speed of processing and inhibitory control in response to a session of acute exercise, but do not experience benefits in planning or set shifting.

Percutaneous portal venoplasty and stenting for anastomotic stenosis after liver transplantation

AIM:To review percutaneous transhepatic portal venoplasty and stenting(PTPVS)for portal vein anastomotic stenosis(PVAS)after liver transplantation (LT). METHODS:From April 2004 to June 2008,16 of 18 consecutive patients(11 male and 5 female;aged 17-66 years,mean age 40.4 years)underwent PTPVS for PVAS.PVAS occurred 2-10 mo after LT(mean 5.0 mo). Three asymptomatic patients were detected on routine screening color Doppler ultrasonography(CDUS). Fifteen patients who also had typical clinical signs of portal hypertension(PHT)were identified by contrastenhanced computerized tomography(CT)or magnetic resonance imaging.All procedures were performed under local anesthesia.If there was a PVAS<75%, the portal pressure was measured.Portal venoplasty was performed with an undersized balloon and slowly inflated.All stents were deployed immediately following the predilation.Follow-ups,including clinical course, stenosis recurrence and stent patency which were evaluated by CDUS and CT,were performed. RESULTS:Technical success was achieved in all patients.No procedure-related complications occurred. Liver function was normalized gradually and the symptoms of PHT also improved following PTPVS.In 2 of 3 asymptomatic patients,portal venoplasty and stenting were not performed because of pressure gradients<5 mmHg.They were observed with periodic CDUS or CT.PTPVS was performed in 16 patients.In 2 patients,the mean pressure gradients decreased from 15.5 mmHg to 3.0 mmHg.In the remaining 14 patients,a pressure gradient was not obtained because of>75%stenosis and typical clinical signs of PHT.In a 51-year-old woman,who suffered from massive ascites and severe bilateral lower limb edema after secondary LT,PVAS complicated hepatic vein stenosis and inferior vena cava(IVC)stenosis. Before PTPVS,a self-expandable and a balloonexpandable metallic stent were deployed in the IVC and right hepatic vein respectively.The ascites and edema resolved gradually after treatment.The portosystemic collateral vessels resulting from PHT were visualized in 14 patients.Gastroesophageal varices became invisible on poststenting portography in 9 patients.In a 28-yearold man with hepatic encephalopathy,a pre-existing meso-caval shunt was detected due to visualization of IVC on portography.After stenting,contrast agents flowed mainly into IVC via the shunt and little flowed into the portal vein.A covered stent was deployed into the superior mesenteric vein to occlude the shunt. Portal hepatopetal flow was restored and the IVC became invisible.The patient recovered from hepatic encephalopathy.A balloon-expandable Palmaz stent was deployed into hepatic artery for anastomotic stenosis before PTPVS.Percutaneous transhepatic internal-external biliary drainage was performed in 2 patients with obstructive jaundice.Portal venous patency was maintained for 3.3-56.6 mo(mean 33.0 mo) and all patients remained asymptomatic.CONCLUSION:With technical refinements,early detection and prompt treatment of complications,and advances in immunotherapy,excellent results can be achieved in LT.

Effect of selective uterine artery embolization on symptomatic uterine fibroids

Objective： To evaluate the outcomes of selective uterine artery embolization （SUAE） in treatment of symptomatic uterine fibroids using Color Doppler ultrasonography （CDUS）. Methods： As the procedure SUAE for fibroids, prospective data of the initial 65 consecutive women treated from March 2007 to September 2009 were collected. The follow-up period from 1 week to 30 months, using questionnaires, we investigated the fibroid-related physical and psychological symptoms, and the cumulative rates of symptom control, gynecologic interventions, and complications. The volumes of uterine and uterine fibroids were calculated by CDUS pre- and post-SUAE for 6 months. And we tested the levels of internal hormone including FSH, LH and E2 before and after SUAE for 3, 6 months. Results： SUAE was performed successfully in all patients. There was no peri-operative morbidity in all procedures. Compared with pre-SUAE volumes of uterine [（322± 12） cm^3] and uterine fibroids [（125±46） cm^3], their volumes in post-SUAE were （144±72） cm^3 and （51 a：l 1） cm^3 （P〈0.01）, and reduction rate was 58% and 61%, respectively. At 3, 6 months after SUAE, levels of FSH, LH, and E2 were not decreased than that of in pre-SUAE （P〉0.05）. After SUAE for 24 months, the fibroids related physical and psychological symptoms such as bleeding, pain and quality of life were significantly improved （P〈0.01）. 90.8% （59/65） women had resolution of symptoms and no significant post-procedural symptoms. Parts of patients discharge necrotic fibroids. 86% （34/40） complications were minor, requiring no therapy. 9.2% （6/65） had significant post-procedural symptoms, requiring therapy in hospital or out-patient department. Conclusion： SUAE contributes to a long-term significant improvement of all investigated uterine fibroid-related symptoms and markedly improves women＇s health-related quality of life. SUAE that no impair on changes of internal hormone, under suitable conditions, represents an attractive alternative to hysterectomy for the treatment of symptomatic fibroids and is a minimally invasive, new method of good clinical prognosis. CDUS is an effective to investigate the outcome of SUAE.

Prevalence of clonorchiasis in patients with gastrointestinal disease: A Korean nationwide multicenter survey

AIM： To investigate prevalence of C/onorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea. METHODS： Consecutive patients who had been admitted to the Division of Gastroenterology with gastrointestinal symptoms were enrolled from March to April 2005. Of those who had been diagnosed with clonorchiasis, epidemiology and correlation between infection and hepatobiliary diseases were surveyed by questionnaire. RESULTS： Of 3080 patients with gastrointestinal diseases, 396 （12.9%） had clonorchiasis and 1140 patients （37.2%） had a history of eating raw freshwater fish. Of those with a history of raw freshwater fish ingestion, 238 （20.9%） patients had clonorchiasis. Cholangiocarcinoma was more prevalent in C. sinensis-infected patients than nonnfected patients [34/396 （8.6%） vs 145/2684 （5.4%）, P = 0.015]. Cholangiocarcinoma and clonorchiasis showed statistically significant positive cross-relation （P = 0.008）. Choledocholithiasis, cholecystolithiasis, cholangitis, hepatocellular carcinoma, and biliary pancreatitis did not correlate with clonorchiasis. CONCLUSION： Infection rate of clonorchiasis was still high in patients with gastrointestinal diseases in Korea, and has not decreased very much during the last two decades. Cholangiocarcinoma was related to clonorchiasis, which suggested an etiological role for the parasite.

Beneficial effects of fucoidan in patients with chronic hepatitis C virus infection

AIM:To evaluate the effects of fucoidan,a complex sulfated polysaccharide extract from marine seaweed,on hepatitis C virus(HCV) RNA load both in vitro and in vivo.METHODS:HCV-1b replicon-expressing cells were cultured in the presence of fucoidan obtained from Cladosiphon okamuranus Tokida cultivated in Okinawa,Japan,and quantified the level of HCV replication.In an open-label uncontrolled study,15 patients with chronic hepatitis C,and HCV-related cirrhosis and hepatocellular carcinoma were treated with fucoidan(0.83 g/d) for 12 mo.The clinical symptoms,biochemical tests,and HCV RNA levels were assessed before,during,and after treatment.RESULTS:Fucoidan dose-dependently inhibited the expression of HCV replicon.At 8-10 mo of treatment with fucoidan,HCV RNA levels were significantly lower relative to the baseline.The same treatment also tended to lower serum alanine aminotransferase levels,and the latter correlated with HCV RNA levels.However,the improved laboratory tests did not translate into significant clinical improvement.Fucoidan had no serious adverse effects.CONCLUSION:Our findings suggest that fucoidan is safe and useful in the treatment of patients with HCVrelated chronic liver diseases.Further controlled clinical trials are needed to confirm the present findings.

Association between interleukin-4 polymorphisms and asthma

Objective:To perform a systematic review and meta analysis on the association of C-589T and C-590T polymorphisms of IL-4 with asthma and to estimate allele frequencies, the magnitude of the gene effect as well as the possible mode of inheritance. Methods: A genetic model-free approach was used to perform a meta analysis. Heterogeneity, sensitivity analysis and publication bias were also explored. Results: Our meta analysis summarized the evidence to date regarding the association of C-589T and C-590T polymorphisms in the promoter region of IL-4 gene with asthma. For C-590T, the results showed a significant recessive genetic model, and the CC genotype was about 24% less likely to have asthma than the genotype CT and TT. Although there was evidence suggesting a recessive genetic model for C-589T, the recessive model was not statistically significant. Conclusion: This meta analysis suggests that there may be an important effect of single nucleotide polymorphisms (SNPs) in the promoter region of IL-4 gene on the pathogenesis of asthma.

Celiac disease manifested by polyneuropathy and swollen ankles

A 27-year-old male started to have his ankles swollen during his military service. He was examined at a military hospital where electromyoneurography showed the signs of distal sensory-motor polyneuropathy with axon demyelinization and weak myopathic changes, whereas histopathological examination of gastrocnemius muscle biopsy revealed some mild and nonspecific myopathy. Besides, he was found to have subcutaneous ankle tissue edemas and hypertransaminasemia. Due to these reasons, he was dismissed from the military service and examined at another hospital where bone osteodensitometry revealed low bone mineral density of the spine. However, his medical problems were not resolved and after the second discharge from hospital he was desperately seeing doctors from time to time. Finally, at our institution he was shown to have celiac disease (CD) by positive serology (antitissue transglutaminase and antiendomysial antibodies) and small bowel mucosal histopathological examination, which showed total small bowel villous atrophy. Three months after the initiation of gluten-free diet, his ankle edema disappeared, electromyoneurographic signs of polyneuropathy improved and liver aminotransferases normalized. Good knowledge of CD extraintestinal signs and serologic screening are essential for early CD recognition and therapy.

Value of identifying and diagnosing mammary carcinoma and non-lactation mastitis lump by color Doppler ultrasonography

Objective: To evaluate the value of identifying and diagnosing mammary carcinoma and non-lactation mastitis lump (NLM) by multicolor Doppler ultrasonography. Methods: We compared and analyzed the examination results of 69 cases of mammary carcinoma proved by surgical pathology and 22 cases of NLM before surgery by multicolor Doppler ultra-sonography. Results: The detection rates of mammary carcinoma and NLM focus by ultrasonic examining were 100%. The shape, envelope, foul line, blood stream between sound and image of two diseases were similar. Of the two diseases, the representation with slight calcification in lump, lower echo in low echo, bloodstream distribution and resistance were different. Conclusion: By analyzing the sound and image representation of mammary lump, we find color Doppler ultrasonography has significant value in identifying and diagnosing mammary carcinoma and non-lactation mastitis lump.